To distinguish between the parent R01 grant and the competitive revision (CS), information relevant to the parent grant is shown in standard text format. Information relevant to the competitive supplementary revision (CS) is shown in italics. The current application is submitted in response to NOT-OD-09-058 ("NIH Announces the Availability of Recovery Act Funds for Competitive Revision Applications"). The parent grant (R01DA026091-01;"Computer vs. Therapist-Delivered Brief Intervention for Drug Abuse in Primary Care") was funded 9/08 in response to DA 08-021 (SBIRT in medical settings). Briefly, the rationale and methods for the parent study are as follows: The vast majority of persons with substance use disorders go undetected and untreated. Proactive screening, brief intervention, and referral for treatment approaches (SBIRT) have tremendous potential for identifying and influencing undetected substance abuse, but efforts to incorporate them in the community have met with substantial obstacles related to training, time, costs, and acceptance. Computer-delivered approaches, on the other hand, are a promising alternative and merit serious consideration, as they have shown beneficial effects on substance use outcomes (e.g., Hester et al., 2005;Ondersma, Svikis &Schuster, 2007). These approaches also have tremendous advantages in terms of replicability, accessibility, and cost. The parent R01 grant identifies primary care patients at risk for heavy/problem alcohol and drug use through a 15-minute, computer-delivered health screen (Health Cheq) that queries patients about nutrition, exercise, sleep and mood as well as alcohol, tobacco and other drug use. Persons who screen at risk for heavy/problem substance use and provide informed consent (N=680) are randomized to one of 4 groups: computer-delivered health screen alone (standard care, SC), assessment only (CA), assessment plus computer-delivered brief motivational intervention (CACI), or assessment plus therapist-delivered brief motivational intervention (CATI). Outcomes (substance use via self- report and urine toxicology) are compared at 1, 3, and 6 months post-randomization. A sophisticated economic analysis will also be performed to compare costs for computer and counselor-delivered interventions. The impetus and rationale for the competitive supplementary revision (CS) are as follows: While the computer-delivered Health Cheq screens for tobacco use, the parent grant does not specifically target cigarette smoking for intervention. This was disappointing to clinicians in the target clinic who report that over one-third (35%) of their patients smoke cigarettes and little is currently being done to address this problem. Smoking harms nearly every organ of the body, causing many diseases and reducing the health of smokers in general (Surgeon General's Report, 2004). The 2008 Practice Guidelines for Treating Tobacco Dependence identifies the 5 A's (Ask, Advise, Assess, Assist, Arrange) as the most promising practitioner-delivered intervention. As with SBIRT above, however, numerous barriers to incorporating the 5 A's intervention into routine clinical practice have been reported (Fiore et al., 2008). This competitive supplement (CS) makes convenient use of the infrastructure already in place through the parent grant to collect benchmark data on the effectiveness of a computer-delivered 5A's intervention for cigarette smoking. The computerized 5A's intervention already exists for prenatal smoking (R21, Ondersma &Svikis). With minor revisions it can be studied in the competitive supplement project. Specifically, the proposed research will compare 1- and 3-month smoking cessation rates in medical patients (N=380) randomized to the computer-delivered 5A intervention or a screening + resource information control group. The CS proposal will not only provide additional employment opportunities for research assistants, it will also increase the rate and number of subjects recruited for the parent grant and provide greater power for secondary analyses. Most importantly, it will inform the field about the efficacy of a computer-delivered 5 A's intervention with both clinical and economic analyses. If outcomes are comparable to those reported in previous practitioner-delivered research, the practical and economic implications of its use will be significant and should ultimately reduce tobacco mortality and morbidity rates in this country. PUBLIC HEALTH RELEVANCE: Although a physician-delivered 5A's approach to smoking cessation is considered the "gold standard" among researchers, the extent to which this intervention has been adopted in routine practice settings is sadly lacking. This competitive supplement will collect benchmark data on smoking cessation rates when the 5A's intervention is delivered entirely via computer-based technology. If outcomes are comparable to those reported in the 2008 practice guidelines for tobacco cessation and better than those found in standard care, the findings would have major practical and economic implications, ultimately assisting more patients in their efforts to stop smoking. This CS interfaces perfectly with the parent R01, which targets heavy/problem alcohol and/or drug use and compares 2 greatly simplified, computer-based approaches to screening and brief intervention to a more traditional, counselor-delivered MI intervention. If one or both of the computer-based approaches yields outcomes comparable to the usual counselor-delivered approach, the simplicity of the computer-based technology would make treatment available to many more persons with drug or alcohol problems as well.